Pharmacotherapy options for managing hepatitis B in children

Introduction: To eliminate viral hepatitis by 2030, the World Health Organization (WHO) launched the first global health sector strategy on viral hepatitis, with particular focus given to hepatitis B and C in 2016. To achieve the reduction of mortality in children, it is indispensable to know which children should be treated and how to treat them. Area covered: In this article, the authors review the antiviral treatment of children with chronic hepatitis B virus (HBV) infection including antivirals available for children with chronic HBV infection. Expert opinion:The approvals of nucleos(t)ide analogues (NAs) and pegylated interferon (PEG-IFN) for children have lowered a hurdle to the initiation of antiviral treatment in children. The international guidelines use nearly the same criteria of antiviral treatment for children with chronic HBV infection, but the WHO guidelines provide a cautious stance on the antiviral treatment of children. Not only PEG-IFN but also NAs with a high genetic barrier to drug resistance should be the first-line treatment for children. In settings with limited medical resources, NAs can be the first-line treatment for children. Although the concept of an 'immune-tolerant phase' is challenged, evidence is not sufficient to recommend the treatment of HBeAg-positive immune-tolerant children.

Automated summary

In order to reduce mortality in children with chronic hepatitis B virus infection, the approvals of nucleos(t)ide analogues (NAs) and pegylated interferon (PEG-IFN) have made antiviral treatment more accessible for children. International guidelines have similar criteria for antiviral treatment of children with chronic HBV, but the WHO guidelines take a cautious approach. Both PEG-IFN and NAs with a high barrier to drug resistance should be considered as first-line treatments for children.